The document outlines an oral health care pilot project at Parkridge Centre that aims to improve oral hygiene for residents. Dental health educators provided oral health assessments, care plans, and staff training. Clinical nurse educators and speech language pathologists were trained to perform assessments and provide daily oral care. Champions were selected from each neighborhood to help train staff and support ongoing oral care. The project resulted in improved plaque scores and oral health for residents over time.
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Parkridge Centre Oral Health Update
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3. Secure oral hygiene products for
residents’ oral health kits.
Develop a variety of oral health
protocols.
Promote the importance of daily oral
care among staff for the residents in their
care.
4. The oral health kit is based on the model
used @ Deer Lodge Centre in Winnipeg.
5. April & May 2014
› In one Parkridge Centre neighborhood, Saskatoon Health
Region – Oral Health Program dental health educators*
(DHEs) provided:
Initial oral health assessments using the Oral Health
Assessment Tool (OHAT)
Plaque index scores for baseline data to determine an
improvement or decline in oral health
Individualized daily oral care plans for each resident who
had an OHAT
Hands-on instruction/demonstration of how to provide
daily oral care for various residents
Referral and follow up of oral lesions or any untreated oral
conditions
Referral to U of S DDS students for exams, complete
treatment plans, hygiene, restorative procedures,
extractions and recall/follow up
*one DHE involved is dually trained as a dental therapist and
dental hygienist which brings an additional skill set to this program.
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7. • This resource was distributed to residents and
their families during the month of April 2014.
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15. Next Steps
› DHEs trained Clinical Nurse Educators (CNE) and
one Speech Language Pathologist (SLP) on how
to perform the OHAT and daily oral care. The
Better Oral Health in Long Term Care training
module was used.
› Provided hands-on demonstration of daily oral
care on the neighborhood with a variety of
residents with varying dentitions and behaviors.
› In the future, CNEs and neighborhood
champions will train Continuing Care Aides
(CCAs)on how to provide daily oral care.
16. CNEs are using life-like mannequins with
oral cavities and teeth, to help staff
become comfortable and competent in
providing oral care.
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20. October 2014
› Residents who were assessed in April/May
received their 6 month OHAT follow-up by dental
health educators and the neighborhood
champions.
› Plaque indices for comparison data were
completed on all residents with natural teeth.
› Any reported lesion for follow-up/observation
was re-assessed for resolution and re-referred if
resolution had not occurred.
21. October 2014 – continued
› All individual oral care plans were updated and tooth
brushes and perivex were replaced if required.
› Any resident who did not have a daily oral care plan in
their washroom was provided with one.
› Any toothettes or mouthwash found in resident’s oral kits
were removed.
› Any resident requiring follow-up for an oral lesion was
referred to CNE and Care Team Manager on the
neighbourhood.
› Chart audits were performed by DHEs. Several Parkridge
Centre residents had been seen by the U of S DDS
residents. Many had received exams and hygiene
treatment and/or will receive complete treatment plans
and restorative treatment and/or hygiene follow-up in the
future.
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23. Our 2 oral health champions were
nominated for a Bravo Award for the
work they have done at Parkridge
Centre in regard to the LTC oral care
pilot project!!
25. Continuous adjustments are being made to
policy, processes, training and resources as
required, until everything flows well.
CNEs will continue adding new
neighborhoods and training front-line staff,
until daily oral care is fully implemented at
Parkridge Centre.
Each neighborhood will have two or more
dedicated oral health champions
depending on the number of residents
residing in each neighborhood.
Rubber handled toothbrush – two tooth brush technique
Proxabrush
Perivex – not to be confused with Peridex
Gel based moisturizer
Antibacterial
Not fluoridated
Great for loosening dried secretions on the tongue and palate
Great for individuals who cannot spit and swallow
-Initially PI and GI were to be performed to have an overview of plaque and gingival health but with the limited cooperation of some or most residents the PI was the easiest index to use as no instruments (probe) were required
-PI can only be scored on individuals with teeth, and scored visually, where as a GI requires the use of a probe
Performing an OHAT
Note PPE – gloves, masks, glasses – ALWAYS
Work in pairs – one examiner, and one recorder (operator/resident safety, infection control and reduced examination time for resident)
Modified to include
-new section exterior of face
-space under each section of the OHAT to make notes
OHAT assessment can be performed anywhere
Resident can be
Sitting
Standing
In bed
What ever time/location or scenario is most comfortable for resident
-Selected residents with different behavioral issues and various dentitions
Ie) CUD/CLD, edentulous, partial dentition
Parkridge Dental Clinic
-One resident deceased since original assessments
-two residents would not cooperate from PI score, an improvement from the last visit where 4 residents would not cooperate, one resident refused on both occasions
-Of the 17 residents with natural teeth:
there was an improvement in 4 resident PI scores
There was no change in 5 resident PI scores
Unable to determine change/improvement in 4 resident PI scores
There was a slight decline in one resident PI score
There was significant decline in two resident’s hard tissues
There was a significant reduction supre and sub cal of one resident
Combined PI Score for the entire facility – 2.34 out of 3
**Ideally for a facility average, I would like to see this number reduced to 1.5-1.8
-still seeing a disconnect with staff about the importance of daily oral care
-many toothbrushes weren’t opened or used
-any restorative treatment won’t hold up in the oral cavity if daily care is not being completed
-champions, CNEs, care team managers and upper management must continue to promote daily oral care and stress the importance of mouth/overall body connection and maintaining residents dignity.
-Paradigm shifts are slow, and we realize it will take time for all staff to buy in to the importance of providing daily oral care.
-removal of all toothetttes from the facility, discontinuing ordering of all toothettes in general
-improved availability of oral care supplies (rubber handled toothbrushes), standardized ordering of oral care products
-dating perivex to track usage
-drafting a dhyphagia policy
-purchasing of Collis Curve toothbrushes? – proven to be very useful and helpful for residents with natural teeth on the dementia unit – to be purchased by the dental department?
-ensuring when residents switch rooms their daily oral care plan follows them
